Advice for doing vaginal exams

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Hi! I a new grad (Graduated in June of 2008) and I have been orienting on a maternity floor since August 1st. Because we're a small hospital, I have to become familiar with nursery, labor and delivery, and post-partum care. I am really struggling with lady partsl exams. My preceptor never showed me how to even do one (which way to stick your fingers in) but I gathered that from watching. The biggest issue I have is figuring out dilation, effacement, and station. I get the idea of each of these concepts, but always seem to just get "lost" in the lady parts. Surprisingly, I have almost "guessed" the dilation correctly on people, but I still feel lost. I've noticed too when people are dilated more that I have a tendency to go in "too far" and I'm touching the baby's head versus the cervix. Any suggestions for grasping lady partsl exams? I know it "takes a long time" to understand that, I would just love some advice or guidance so I don't get discouraged.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

If you are getting to the baby's head, that is ok.....just back down and find the cervical borders once you do. Really, you need to be finding the head, anyhow, for the simple reason of needing to know the what presenting part is, and what direction it's facing, e.g. LOA, OP etc. You want to know when there is a problem with how the baby presents as there are sometimes things you can do to help.

Effacement, I don't get all caught up in. If it's thick, it's thick. 50% is like your lower lip in thickness. 90-100, like the skin between your thumb and forefinger, or membranous. Anything else, well, to me is not too critical to know. Most of the time, I just define as "thick", 50%, 75-80% , 90% or fully effaced. Most of it is so subjective. This comes with practice.

Same with station. Imagining where her ischial spines are, helps. If the presenting part is there, you are at zero station. Anything above, is -1, -2 and so far. It's helpful to feel if the head is "ballotable", meaning when you put gentle pressure on it, it floats away. This to me, is pretty important. The doctor won't want to break water on a ballotable head, in order the cord will not prolapse. If the presenting part is below the spines, you are now in "plus" territory. Again, this takes practice.

There are a lot of good threads on this subject, with people offering excellent advice, better-worded than I have done. You are welcome to try a search and see what there is to offer.

Be patient with yourself. I was exactly where you are now, just 11 years ago. I still have others check behind me when I am unsure. It's ok to ask for help and backup when you are unsure. Never be afraid to do that!!!!! Even after 11 years, I do this from time to time.

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Specializes in L&D.

I'm new at this also, but a good trick i've found with dilatation is I take a measuring tape out of our baby warmer tear it off just past the 10 cm mark, and after I have checked my pt I line my fingers up with what I felt on the cm lines and there you have it. Works everytime!

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Specializes in L&D, QI, Public Health.
I'm new at this also, but a good trick i've found with dilatation is I take a measuring tape out of our baby warmer tear it off just past the 10 cm mark, and after I have checked my pt I line my fingers up with what I felt on the cm lines and there you have it. Works everytime!

I think this a good trick, but I've done something similiar with maps to figure out distance and I invariably move my fingers closer than the original width

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Also remember you can use the monitor paper for an estimate, too. One minute equals 3cm in the USA. This was helpful for me in those ealy days when I was learning all the tricks of our trade.

Welcome to our forum, and GOOD LUCK!

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Thanks so much for the links :) I did a search but I was getting everything BUT what I was looking for :) It sort of sounds like I'm just going to have to hang in there. I've found I don't get as many opportunities for learning on third shift since no one is "scheduled" during those hours. I'll have patience :) Thanks again for the links - they had some great tips in there!

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I have very short fingers, so SVE's have been something I've worried about myself. I had a preceptor that showed me how to do a SVE and she sits on the bed to do it. I can't do it that way, my hand gets all twisted and I think it shortens my already short fingers. Instead I stand next to the bed. Usually I can find the cervix pretty quickly, if you know how dilated the pt is that helps a lot. If they're 1-2, 50% you know it may be difficult to find and is usually posterior (but sometimes to the side as well). I'm still working on figuring out station, but I usually go by how high the baby's head feels to me, if I really have to reach for it etc. If they've got an epidural then it's a lot easier and I have started to feel for the spines and really try to get a correct station. One trick I was just taught a couple of months ago was when a pt gets to be 6-7 it can be difficult for me to find one side of the cervix and stretch my fingers to the other side (again, short fingers don't help). Instead I count from the edge of the cervix to the lady partsl wall, so two fingers side to side would be 7 cm, 1.5 fingers would be 8 cm dilated, does that make sense?

I also took the baby measuring tape and taped it corner to corner on the back of my badge (it's exactly 10 cm) . I do the exam, wash my hands and then compare what I got to the measuring tape. I've been pretty accurate so far (except with some of the docs who want the pt to be a certain dilation, lolol).

In the end, it all just takes practice. Volunteer to check ahead of any nurses as long as the pt agrees. The more you do the better you'll become and you'll pick up your own little tricks.

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Specializes in many.

Here's another trick I was taught early on because I had a problem with keeping my fingers at the same position once I got out of the lady parts.

Place your other hand on a solid surface (I usually use my thigh) and spread the fingers of both hands to the same width so you can see before you remove your hand.

I have heard of some places using a (sorry for the crudeness) "twat box" for practicing, but I haven't seen one.

Anyone seen or used one?

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Here's another trick I was taught early on because I had a problem with keeping my fingers at the same position once I got out of the lady parts.

Place your other hand on a solid surface (I usually use my thigh) and spread the fingers of both hands to the same width so you can see before you remove your hand.

I have heard of some places using a (sorry for the crudeness) "twat box" for practicing, but I haven't seen one.

Anyone seen or used one?

I only saw that box once at an AWHONN monitoring class that we used to place FSE's there was a little baby model inside and you opened the box to see where you placed the lead...no fair if they put the baby in there breech :)

Checking just takes practice. After years every now and then I still ask for a 2nd opinion

Make sure you pt has voided prior to checking so that cervix isn't higher up in the air. It's easier to check if your doc uses and IUPC just follow it up.

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Ck and see if they training items in house. When I did my preceptorship during my senior hours the hospital I was at had cervix items you could learn from. My preceptor had me close my eyes and put my hand in....it was called a lady parts in a Box and figure out the different dilations. There was a few other items we practiced with for Leopolds, etc.

I was pretty much told that it takes years of practice to get GREAT at it. Just do your best and ask for the opportunity to check everyone....even if it is someone's patient. That was the advice they gave me....and most pts are fine with it....heck I have had 2 kids and it is like whats one more check...esp for learning sake.

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Specializes in L&D,postpartum nursery.

there is a flip book that our dept got. as you flip the pages over the cervix goes from closed to fully dilated, when i go to work on friday i will see if I can find out where we got it and let you know, it was very helpful when we were training 3 nurses and multiple checks might have been torturous

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